An 80-year-old woman is brought in by ambulance in the summer after being found in her home by her husband dazed and confused. Body temperature is 106 F.

Which of the following is the most likely explanation for this patient’s hematologic findings?

A) Asplenia
B) Coombs test-positive hemolytic anemia
C) Liver failure
D) Microangiopathic hemolytic anemia
E) Sepsis

A) Autoimmunity
B) Deficiency of erythrocyte spectrin
C) Deficiency of NADPH production
D) Inhibition of ferrochelatase and δ-ALA dehydratase
E) Loss of lymphoid organ

A 53-year-old woman is evaluated in hospital for a 6-month history of fatigue, lymphadenopathy, and easy bruising. Leukocyte count is 80,000/μL, with 89% lymphocytes. Hemoglobin is 9 g/dL. A Coombs test is positive.

Which of the following is most likely to be seen in this patient?

A) CD5/23 positivity
B) CD10 + TdT positivity
C) Intravascular hemolysis
D) t(9;22)
E) t(15;17)

A 3-year-old boy is brought to the pediatrician by his mother for a wellness check. Physical examination shows a single palmar crease, slanted palpebral fissures, and epicanthal folds. Which of the following additional findings is most likely to be seen in this patient?

A) Bird’s beak sign
B) Coffee bean sign
C) Double bubble sign
D) Increased lymphoblasts
E) Target sign

A 63-year-old woman comes to the physician for a follow-up appointment. Her serum protein electrophoresis is shown.

Which of the following is most likely to develop in this patient?

A) Blurry vision
B) Hypocalcemia
C) Low mean corpuscular volume
D) Nephrotic syndrome
E) Systolic dysfunction

A 26-year-old woman comes to the physician for a follow-up appointment. She recently had a miscarriage and wants to discuss options for future care.

Which of the following is the most likely to be seen in this patient?

A) Anti-cyclic citrullinated peptide antibodies
B) Anti-histone antibodies
C) Increased partial thromboplastin time
D) Increased platelet count
E) Syphilis

A 7-year-old boy is brought to the physician by his mother. A blood smear is shown.

Which of the following is most likely to be seen in this patient?

A) Decreased NADH production
B) Decreased disulfide group production
C) Decreased thiol group production
D) Dominant inheritance pattern
E) Howell-Jolly bodies

A 25-year-old man comes to the physician for a follow-up appointment. Hydroxyurea therapy is prescribed. Which of the following is most likely to be seen in this patient as a result of this pharmacotherapy?

A) Decreased sickle hemoglobin expression
B) Decreased sickling due to decreased acidification
C) De-repression of fetal globin chain genes
D) Increased HbA2 production
E) Increased thymidine fraction

A 64-year-old man is being managed in hospital for a hematologic condition. During the course of his chemotherapy, he develops bleeding from IV lines. A blood smear is shown.

Which of the following is most likely to be seen in this patient?

A) Decreased fibrinogen
B) Decreased fibrin degradation products
C) Decreased plasmin activity
D) Decreased prothrombin time
E) Increased plasminogen

A 12-year-old girl is brought to the physician for a follow-up appointment. She has had no recent illnesses. Vitals are normal. Her had a history of “anemia” that was treated with splenectomy in early adulthood. A blood smear is shown.

If left untreated, this patient is at greatest risk for developing which of the following?

A) Cholelithiasis
B) Coombs test positivity
C) Disseminated intravascular coagulation
D) Microangiopathic hemolytic anemia
E) Normal ferritin with decreased serum iron